Spinal Cord Injury

“To see Jack and how healthy and positive he appears, it can be easy to forget how hard this is,” said Jack’s mom. “A spinal cord injury like Jack’s does more than keep him in a chair. Paralysis like this makes a body very fragile; it affects every system in his body. And it affects everything he does. And it affects everyone around him. Life is never simple with a spinal cord injury.” July 2013

Q: What is spinal cord injury?

The Spinal Cord

To understand what can happen as the result of a spinal cord injury, it is important to understand the anatomy of the spinal cord and its normal functions.

The spinal cord is a tight bundle of neural cells (neurons and glia) and nerve pathways (axons) that extend from the base of the brain to the lower back. It is the primary information highway that receives sensory information from the skin, joints, internal organs, and muscles of the trunk, arms, and legs. The spinal cord then relays this information upward to the brain. The cord also carries messages downward from the brain to other body systems.

Millions of nerve cells situated in the spinal cord itself also coordinate complex patterns of movements such as rhythmic breathing and walking. Together, the spinal cord and brain make up the central nervous system, which controls most functions of the body.

Source: National Institutes of Health

Image source: medicalterms.info

Because the spinal cord is such an important part of our nervous system, it is surrounded and protected by a series of stacked bones (vertebrae) called the spinal column.  The spinal cord is about 18 inches long, extending from the base of the brain, down the middle of the back, to about the waist. The spinal column is divided into four sections: (1) at the top are 8 cervical vertebrae; (2) next are 12 thoracic vertebrae; (3) the lower back has 5 lumbar vertebrae; (4) at the bottom are 5 sacral vertebrae fused together into one bone. 

The spinal cord after injury

A spinal cord injury (SCI) is one of the most devastating of all traumatic events.  In most injuries, bone, ligaments, or disc material pinch the spinal cord causing bruising or a tear in the spinal cord and/or its nerve fibers. After a SCI, all the nerves above the level of injury keep working like they always have. From the point of injury and below, the spinal cord nerves cannot send messages between the brain and parts of the body like they did before the injury.

SCI damage can result in paralysis of the muscles used for breathing; paralysis and/or loss of feeling in all or some of the trunk, arms, and legs; weakness; numbness; loss of bowel and bladder control and sexual function; and numerous long term conditions. 

A person's injury is described by its level and type. The level of injury for a person with SCI is the lowest point on the spinal cord below which there is a decrease or absence of feeling and/or movement. The higher the spinal cord injury is on the vertebral column, or the closer it is to the brain, the more effect it has on how the body moves and what one can feel. 

Image source: serious-injuries.com 

Tetraplegia [formerly called quadriplegia] is the condition of a person with a spinal cord injury in the cervical region causing loss of feeling and/or movement in the head, neck, shoulder, arms and/or upper chest, stomach, hips, legs, and feet.

Paraplegia is the general term describing the condition of a person who has lost feeling and/or is not able to move the lower parts of his/her body.

Q: What is lost when the spinal cord is injured?

Spinal cord injury (SCI) damage can result in paralysis of the muscles used for breathing; paralysis and/or loss of feeling in all or some of the trunk, arms, and legs; weakness; numbness; loss of bowel and bladder control and sexual function; and numerous long term conditions.

Any damage to the spinal cord is a very complex injury.  There are no tests at this time to tell how many nerves, if any, will begin to work again or when this will occur.

Some individuals have involuntary movements, such as twitching or shaking, called spasms. Spasms are not a sign of recovery.  In addition to loss of movement and feeling, a SCI affects how other systems of the body works, including 

  • Musculoskeletal, resulting in incomplete or complete paralysis (paraplegia or tetraplegia)
  • respiratory and heart problems
  • urinary, bladder and bowel dysfunction
  • gastrointestinal
  • psychological side effects such as depression and anxiety.
  • chronic pain

Successful recovery depends upon how well these chronic conditions are handled day to day.

Q: How many people have a spinal cord injury?

Current figures from the Dana and Christopher Reeve Foundation report that 1.3 million Americans are living with a spinal cord injury (SCI) today, and another 6 million American live with paralysis from various other causes. 

And that number keeps growing.

The hospital in Minneapolis where Jack was taken immediately following his injury receives on average one new SCI patient every week.

Every year, more than 12,000 Americans experience a spinal cord injury.  That is 12,000 more people every year who will need both care, as well as on opportunity for recovery to regain abilities that are lost to a spinal cord injury.

Safety precautions and prevention efforts are important first steps to reducing the number of people suffering a traumatic of injury, but as long as people live active lives injuries will occur.  Bad things can happen during activities on ice, snow, water, grass, and roads -- even when everything is done right.

The National Institutes of Health reports that the largest proportion of spinal cord injuries (36.5 percent) occurs during car accidents; more than a quarter (28.5 percent) are the result of falls; the rest are due to acts of violence, primarily gunshot wounds (14.6 percent) and other unknown causes (11.4 percent).  Sporting accidents account for the smallest portion of injuries (9.2 percent).

The average age at the time of injury has risen in recent years, and is now 42.6 years, with 80% of spinal cord injuries occurring in men.

 Source: National SCI Statistical Center, University of Alabama

Q: What are the costs associated with a spinal cord injury?

The U.S. National Institute of Health (NIH) reports that the cost to our country for managing the care of spinal cord injury (SCI) patients is $3 billion each year.

To the individual living with a SCI and his or her family, the lifetime costs resulting from this injury and living with paralysis and its complications total in the millions of dollars.

For an injury like Jack’s, the lifetime costs are estimated to be between $3.38 million and $4.63 million (based on analysis for someone who is age 25 at time of injury at a high tetraplegia (C1-C4) level; Jack was injured at age 16).  These costs includes the average yearly health care and living expenses related to the injury as well as other lifetime costs that are directly attributable to a SCI.

This estimate does not include any indirect costs such as losses in wages, fringe benefits and productivity which average an additional $64,443 per year over the lifetime of a person living with a SCI. 42% of people with a SCI report being unemployed.

Life expectancy for a male injured at age 20 with high (C1 - C4) tetrapalegia is less than
40 years old.

Source: National SCI Statistical Center, University of Alabama

Q: What is the history of spinal cord injury treatment?

Effective care and treatment for people who have suffered an injury to their spinal cord injury is a relatively new medical development.

For most of human history, spinal cord injury care focused on survival, not recovery.  Until World War II, a serious spinal cord injury (SCI) usually meant certain death. As recently as the 1940s, most patients with a spinal cord injury died within in a few weeks.  As surgical procedures and antibiotics improved, by the 1950s average life expectancy increased to nearly 20 years post injury.

Even with these improvements, anyone who survived such injury relied on a wheelchair for mobility in a world with few accommodations and faced an ongoing struggle to survive secondary complications such as breathing problems, blood clots, kidney failure, and pressure sores.

As life expectancy post-injury improved, more attention turned to rehabilitation and quality of life issues.  In the SCI field, many people refer to two periods when describing the history of SCI therapy:  before and after Christopher Reeve.

Christopher Reeve had a horse-riding accident in 1995 that caused a spinal cord injury.  Until his death in October 2004, his insistence that there must be a ‘cure’ for a SCI and its many complications lead to slow but steady changes in SCI research and public policy.  According to researchers at the University of California – Irvine, "in the years following his injury, Christopher did more to promote research on spinal cord injury and other neurological disorders than any other person before or since.”

In 2002, the Christopher and Dana Reeve Paralysis Resource Center, a federal government facility created through a Centers for Disease Control and Prevention grant, was opened in New Jersey. Its mission is to teach paralyzed people to live more independently. Reeve said at the time the Center opened, "When somebody is first injured or as a disease progresses into paralysis, people don't know where to turn. Dana and I wanted a facility that could give support and information to people. With this new Center, we're off to an amazing start." 

Among the many achievements from Christopher’s crusade for improved SCI recovery treatment was the development of locomotor therapies and the formation of the Neurorecovery Network, a group of sites around the country providing this form rehabilitation and exercise regime. 

Courage Kenny Institute and its ABLE Program is a member of the Neurorecovery Network.

Source: "The historical evolution of the management of spinal cord injury,” M.D. Schiller, R.J. Mobbs; Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Department of Neurosurgery, Prince of Wales Hospital, Randwick, New South Wales, Australia

For more information on the history and current research progress in SCI treatment, visit:

Christopher & Dan Reeve Foundation

National Institute of Neurological Disorders